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2 Introduction In the United States, the poor face substantial barriers in life: Typically have worse health than the affluent Are treated within the framework of welfare medicine Live in disadvantaged urban and rural locales

3 Introduction Socioeconomic status or social class is the strongest and most consistent predictor of a person s health and life expectancy across the life course regardless of access to health care or health care delivery system

4 The Components of Social Class A social class is a category or group of people who have approximately the same amount of wealth, status, and power in a society Different models exist: Five-class model used in the U.S.: Upper class Upper-middle class Lower-middle class Working class Lower class

5 The Components of Social Class Europeans tend to focus more on occupational differences as the chief component of class position American sociologists usually rely on socioeconomic status (SES) Influenced by theories of Karl Marx and Max Weber Wealth an important component but Weber also included social status and power Measured by three variables: Income Occupational prestige Education

6 The Components of Social Class Education appears to be the most important component of SES in predicting health outcomes Influences: Knowledge about healthy lifestyles Seeking preventive care or medical treatment for health problems when needed Likelihood of having better income and satisfying jobs

7 The Components of Social Class Importance of individual components of SES and their impact on health varies over the life course Education influences the onset of chronic diseases Income becomes more important later in life; determines how health problems progress

9 Modern Diseases and the Poor Chronic diseases are most associated with modernization and were associated with upper classes Lifestyle changes among the affluent have reduced their risks of chronic diseases Poor more likely to suffer from: Infectious diseases Chronic diseases Mental illness

10 Modern Diseases and the Poor Richard Wilkinson s income inequality hypothesis Blames degree of inequality among classes within a society for health inequalities Society s overall level of wealth less important Compelling argument but thus far findings in other research have not supported his position

11 Equality of Care in Britain After World War II, socialized medicine was introduced in Great Britain Provides the lower classes with the same medical care available to the upper classes Only access to health care was equalized social class differences unchanged

12 Equality of Care in Britain Equalization of health care alone has not reduced the disparity in health between social classes Black Report in 1980 sponsored by British government Assessed trends in population health Demonstrated health inequalities were not decreasing among different social classes despite increased welfare services

13 The Social Gradient in Mortality Whitehall studies conducted by Marmot Showed social class differences in mortality among British male civil government employees Regardless of the cause, those with the highest occupational rank had the lowest percentage of deaths Mortality increased across each job category Lowest-ranked occupations had the highest percentage of deaths

14 The Social Gradient in Mortality

15 The Social Gradient in Mortality Social gradient observed even among relatively high ranked groups, where poverty was not an issue Differences in mortality were linked to hierarchy rather than deprivation Observed in numerous countries, regardless of the specific variable used to indicate social position

16 The Social Gradient in Mortality Possible reasons for gradient include differences between classes in: Self-esteem and stress levels Effects of income inequality Deprivation through life course Health lifestyles and social support Socioeconomic environment Use of preventive health services

17 Neighborhood Disadvantage Five features of neighborhoods that can affect health: 1) Physical environment 2) Surroundings at home, work, and play 3) Services provided to support people 4) Sociocultural aspects of the neighborhood 5) Reputation of an area

18 Neighborhood Disadvantage Orderly neighborhoods are clean and safe, houses and buildings are well maintained, and residents are respectful of each other and each other s property Disorderly neighborhoods reflect a breakdown in social order, as there is noise, litter, poorly maintained houses and buildings, vandalism, graffiti, fear, and crime

19 SES as a Fundamental Cause of Sickness and Mortality SES can be described as a direct cause of poor health because it: 1) Influences multiple diseases 2) Affects these diseases through multiple pathways of risks 3) Is reproduced over time 4) Involves access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs

20 SES as a Fundamental Cause of Sickness and Mortality The degree of socioeconomic resources a person has or does not have, such as money, knowledge, status, power, and social connections, either protects health or causes premature mortality

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